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Care outcomes in long-term care facilities in british Columbia, Canada. Does ownership matter?

McGregor MJ, Tate RB, McGrail KM, Ronald LA, Broemeling AM, Cohen M

Department of Family Practice, University of British Columbia and Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology and Evaluation, Family Practice Research Office, Vancouver, BC, Canada. mrgret@interchange.ubc.ca

OBJECTIVES: This study investigated whether for-profit (FP) versus not-for-profit (NP) ownership of long-term care facilities resulted in a difference in hospital admission and mortality rates among facility residents in British Columbia, Canada. RESEARCH DESIGN: This retrospective cohort study used administrative data on all residents of British Columbia long-term care facilities between April 1, 1996, and August 1, 1999 (n = 43,065). Hospitalizations were examined for 6 diagnoses (falls, pneumonia, anemia, dehydration, urinary tract infection, and decubitus ulcers and/or gangrene), which are considered to be reflective of facility quality of care. In addition to FP versus NP status, facilities were divided into ownership subgroups to investigate outcomes by differences in governance and operational structures. RESULTS: We found that, overall, FP facilities demonstrated higher adjusted hospitalization rates for pneumonia, anemia, and dehydration and no difference for falls, urinary tract infections, or DCU/gangrene. FP facilities demonstrated higher adjusted hospitalization rates compared with NP facilities attached to a hospital, amalgamated to a regional health authority, or that were multisite. This effect was not present when comparing FP facilities to NP single-site facilities. There was no difference in mortality rates in FP versus NP facilities. CONCLUSIONS: The higher adjusted hospitalization rates in FP versus NP facilities is consistent with previous research from U.S. authors. However, the superior performance by the NP sector is driven by NP-owned facilities connected to a hospital or health authority, or that had more than one site of operation.

Published 26 September 2006 in Med Care, 44(10): 929-35.
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